Antihypertensive drugs for hyperuricemia in patients with hypertension: a systematic review and network meta-analysis of Chinese trials.

OBJECTIVE

This study aimed to compare and rank antihypertensive agents based on their urate-lowering effects in patients with hypertension and hyperuricemia.

METHODS

We systematically searched PubMed, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure, and the Wanfang databases for eligible trials published up to September 2023. Randomized controlled trials that directly compared different antihypertensive agents in hypertensive patients with hyperuricemia were included. Pairwise and network meta-analyses were conducted using odds ratios and weighted mean differences with 95% confidence intervals. The surface under the cumulative ranking area (SUCRA) was used to rank the efficacy of the antihypertensive treatments.

RESULTS

A total of 172 trials involving 16,226 hypertensive patients with hyperuricemia were included in the final analysis. According to SUCRA values, losartan plus amlodipine (SUCRA: 96%), valsartan plus amlodipine (SUCRA: 90%), and allisartan (SUCRA: 90%) showed relatively superior effects in reducing serum uric acid levels. Additionally, irbesartan plus amlodipine (SUCRA: 94%), losartan plus amlodipine (SUCRA: 92%), and losartan (SUCRA: 84%) were associated with higher effective rates.

CONCLUSION

Based on the only available eligible evidence, the combination of losartan and amlodipine was the optimal dual therapy for Chinese patients with hypertension and hyperuricemia, while allisartan and losartan were the most effective monotherapies for lowering serum uric acid. These findings are not generalizable to non-Chinese populations, reflecting a gap in global evidence rather than intentional study scope restriction.